Perforated obturator Littr hernia in an elderly woman

Abstract

Obturator hernia is an uncommon condition. It carries the highest mortality amongst abdominal wall hernias, usually presenting in elderly, multiparous and thin ladies. Meckel diverticulum is a rare cause of intestinal obstruction and its existence in an obturator hernia is extremely rare; our literature search revealed only two reported cases. We report the case of a 70-year-old woman who presented with signs and symptoms of intestinal obstruction and peritonitis. An exploratory laparotomy led to diagnosis of a strangulated obturator hernia. The sac contents included a Meckel diverticulum with a perforation at its base and a loop of the ileum. The ischemic ileal segment including the Meckel diverticulum was resected and a loop ileostomy was created.

Figure 1

A view of the femoral and obturator canals. Note the passage of the Meckel’s diverticulum through the latter.

Figure 2

A three-panel image showing the resected gut segment with the Meckel’s diverticulum. Note the perforation at the base of the diverticulum in the first and second panel. The third panel shows a segment of the ischemic gut that was resected.